HomeMy WebLinkAbout0038 Declaration of Domicile and Citizenshi
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498461
Tom cLF.z:IC o~~ cmcvrrcovl~r.
ST. LUG 1 E ppt~y. ~,p~A;
Ibis is ~ declaration az De®ie31e sad (ktiseaship in the. State at lz7or~ida that I am i~ this dq is aoeordasx. sad to
• contacmity with Section 222.17. Florida Statutes.
I was f rmer a Iega1 Teiident oI K*`~+'~.l d ~ Wr?at Ger~Any ~ ap,a I .
ICit71 1&~l
resided at However. I have changed my domieDs to
1 sad Nn~bK)
and am sad love been a bans i5de resident of the State a[ Fbrida sins ----Atari 1 1. 1989 day ~
19_.... sad I reside at 2400 S. Ocean Dr. ADt. 3914
18trMt atl Nmb~ •
Ft. Pierce. Fla. ST. LUG I E
(014) Cooaty. Flassds.
and this stateme~ is to bs taken u my dseLration at7dtlriKiliwtp, actual Iega1 reaidenoe and domicile is the State el ~orida.
- IF FOR THE PURPOSE OF ENROLt.tNG IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCMOOt, PLEASE STATE PLEASE CHECKS
THEIR NANESS
• Sao sFQ -s e~ r s8
- - vaEO ~?~a ~_cuaa o
sl.lucl~ couNTY F a.
ROGER POITRAZ~
CLERK CIRCUIT COURT v
R[CORG ~'ERIFtEO. -_.~-r----
- 498461
. •
I
I FUAT~R CERTII+'Y that I wi11
' register at my k+eal address when the registration books reopen. sad oomph with all
I other requbements d a legal resident olt this State.
f I FtJA17iER CEIiTti'R that I Gave no intention to retm~n tom former domiu7e. sad I intend to remain in
_ U C 1 E Cooaty.
- ICIi4)
! Florida. permaaentu; .
•
\ ~OUlyryco
J ti
v s aG ? G~E%eC~
o~ a t ~
V : 1ti
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~ll,'`•~aa wE ia~g'~~`O~ SV1Via Maria J11llmnann Collins
2400 S. Ocean Dr.. Apt 3914
' IAdi~
- Sworn toaod wbeei~sd bafoee me this 5th day at Ft. Pierce, Fla. 33450
~ September ~ - .
A.D.1~_~
I
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ROGER POI'iRAS. CLERK OF GIRCUi T CO~ItT
ST. LUGIE COUNTY, fLOR10A
•
~ EPUTY LERK - 3
PAGE e)p
a
A ~O Form 22
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